White matter tract integrity in treatment-resistant gambling disorder

Betting on Your Feelings: The Interplay between Emotion and Cognition in Gambling Affective Task

Background: Gambling Disorder (GD) is a bio-psycho-social disorder resulting from the interaction of clinical, cognitive, and affective factors. Impulsivity is a crucial factor in addiction studies, as it is closely linked to cognitive distortions in GD by encompassing impulsive choices, motor responses, decision-making, and cognitive biases. Also, emotions, mood, temperament, and affective state are crucial in developing and maintaining GD. Gambling can be used as a maladaptive coping strategy to avoid or escape problems and distress. Methods: The aim of the present study is to explore differences in personality traits and emotion regulation of people suffering from GD, substance-dependent gamblers (SDGs), and healthy controls (HCs). Additionally, the study proposes a new experimental task: the "Gambling Affective Task" (GAT) to investigate the influence of affective priming on risk-taking behaviors. Results: Our findings indicate that participants placed lower bets following positive priming. Additionally, SDGs wagered significantly higher amounts than HCs, regardless of priming type. In general, participants exhibited longer response times after positive priming trials, compared to negative and neutral priming trials. These findings suggest that experiencing positive emotions can act as a protective factor by delaying and lengthening gambling behaviors. By comparing gamblers with and without substance comorbidity, we can gain insight into the exclusive factors of GD and improve our understanding of this disorder. Conclusions: By elucidating the impact of emotional states on risk-taking, the research also provides new insights into the prevention and treatment of GD.

Precision Behavioral Management (PBM) and Cognitive Control as a Potential Therapeutic and Prophylactic Modality for Reward Deficiency Syndrome (RDS): Is There Enough Evidence?

This brief commentary aims to provide an overview of the available and relatively new precision management of reward deficiencies manifested as substance and behavioral disorders. Current and future advances, concepts, and the substantial evidential basis of this potential therapeutic and prophylactic treatment modality are presented. Precision Behavioral Management (PBM), conceptualized initially as Precision Addiction Management (PAM), certainly deserves consideration as an important modality for the treatment of impaired cognitive control in reward processing as manifested in people with neurobiologically expressed Reward Deficiency Syndrome (RDS).

The neural basis of gambling disorder: An activation likelihood estimation meta-analysis

Previous imaging studies suggested that impairments of prefrontal-striatal and limbic circuits are correlated to excessive gambling. However, the neural underpinnings of gambling disorder (GD) continue to be the topic of debate. The present study aimed to identify structural changes in GD and differentiate the specific brain activity patterns associated with decision-making and reward-processing. We performed a systematic review complemented by Activation likelihood estimation (ALE) meta-analyses on morphometric and functional studies on neural correlates of GD. The ALE meta-analysis on structural studies revealed that patients with GD showed significant cortical grey-matter thinning in the right ventrolateral and ventromedial prefrontal cortex compared to healthy subjects. The ALE meta-analyses on functional studies revealed that patients with GD showed a significant hyperactivation in the medial prefrontal cortex and in the right ventral striatum during decision-making and gain processing compared to healthy subjects. These findings suggest that GD is related to an alteration of brain mechanisms underlying top-down control and appraisal of gambling-related stimuli and provided indications to develop new interventions in clinical practice.

Quality of life instruments used in problem gambling studies: A systematic review and a meta-analysis

The purpose of this systematic review was to identify the instruments used in original articles to measure quality of life (QOL) or health-related QOL (HRQOL) in gambling-disorder patients and to assess their suitability. The systematic literature search to identify QOL/HRQOL instruments used among gambling-disorder patients was performed in PubMed, Embase and PsycINFO databases up to November 2018. A meta-analysis was performed to study the effect size of the QOL/HRQOL instruments and gambling outcomes after an intervention. Thirty-five studies were included. Seven types of instruments aiming at measuring QOL/HRQOL were identified. These instruments explored twenty-six domains. The instruments used were not properly validated in the studies. Most of the clinical trials reported a significant difference in QOL/HRQOL between pre- and post-intervention. These results were concordant with gambling outcomes but had a smaller effect size than gambling outcomes. The currently used general instruments are efficient to measure a significant change after an intervention but might not evaluate specific areas of health related QOL impacted by gambling disorders.

Neuroimaging of reward mechanisms in Gambling disorder: an integrative review

Gambling disorder (GD) was reclassified as a behavioral addiction in the DSM-5 and shares clinical and behavioral features with substance use disorders (SUDs). Neuroimaging studies of GD hold promise in isolating core features of the addiction syndrome, avoiding confounding effects of drug neurotoxicity. At the same time, a neurobiologically-grounded theory of how behaviors like gambling can become addictive remains lacking, posing a significant hurdle for ongoing decisions in addiction nosology. This article integrates research on reward-related brain activity (functional MRI) and neurotransmitter function (PET) in GD, alongside the consideration of structural MRI data as to whether these signals more likely reflect pre-existing vulnerability or neuroadaptive change. Where possible, we point to qualitative similarities and differences with established markers for SUDs. Structural MRI studies indicate modest changes in regional gray matter volume and diffuse reductions in white matter integrity in GD, contrasting with clear structural deterioration in SUDs. Functional MRI studies consistently identify dysregulation in reward-related circuitry (primarily ventral striatum and medial prefrontal cortex), but evidence is mixed as to the direction of these effects. The need for further parsing of reward sub-processes is emphasized, including anticipation vs outcome, gains vs. losses, and disorder-relevant cues vs natural rewards. Neurotransmitter PET studies indicate amplified dopamine (DA) release in GD, in the context of minimal differences in baseline DA D2 receptor binding, highlighting a distinct profile from SUDs. Preliminary work has investigated further contributions of opioids, GABA and serotonin. Neuroimaging data increasingly highlight divergent profiles in GD vs. SUDs. The ability of gambling to perpetually activate DA (via maximal uncertainty) may contribute to neuroimaging similarities between GD and SUDs, whereas the supra-physiological DA effects of drugs may partly explain differences in the neuroimaging profile of the two syndromes. Coupled with consistent observations of correlations with gambling severity and related clinical variables within GD samples, the overall pattern of effects is interpreted as a likely combination of shared vulnerability markers across GD and SUDs, but with further experience-dependent neuroadaptive processes in GD.

All Wrapped Up: Environmental Effects on Myelination

To date, studies have demonstrated the dynamic influence of exogenous environmental stimuli on multiple regions of the brain. This environmental influence positively and negatively impacts programs governing myelination, and acts on myelinating oligodendrocyte (OL) cells across the human lifespan. Developmentally, environmental manipulation of OL progenitor cells (OPCs) has profound effects on the establishment of functional cognitive, sensory, and motor programs. Furthermore, central nervous system (CNS) myelin remains an adaptive entity in adulthood, sensitive to environmentally induced structural changes. Here, we discuss the role of environmental stimuli on mechanisms governing programs of CNS myelination under normal and pathological conditions. Importantly, we highlight how these extrinsic cues can influence the intrinsic power of myelin plasticity to promote functional recovery.